In accordance with this letter of intent (LOI), the Directorate invites the Ministry of Health to cooperate in the field of research within the framework of a project entitled: “Monitoring of selected zoonotic and vector-borne diseases among patients with fever in a hospital setting (hereinafter referred to as the "febrile diseases study"). The Directorate is the newest foreign laboratory of the research institute and is a tenant integrated into the center in Georgia. The Directorate initiated the work of our laboratory at the end of 2012 and continues to increase the opportunities for research and observation in the South Caucasus region.  American scientists work in the United States in support of various scientific research.  Febrile illness is one of the Directorate's research interests, and it will be the first joint project with the institutions. 

In recent years, several studies have reported that endemic and emerging zoonotic infections such as anthrax, leptospirosis, leishmaniasis, brucellosis, Crimean Congo hemorrhagic fever, and Handvirus infection are circulating in the South Caucasus region. Despite the growing evidence that Armenian residents may be susceptible to these zoonotic infections, little is known about the likely causes of febrile diseases in the country. 

The main purpose of this study is to determine the relative incidence of infectious etiology of undifferentiated febrile diseases in the country in order to improve the detection, treatment, prevention and control of these pathogens.

The secondary objectives are to:
1. Identify epidemiological risk factors for specific pathogens.
2. Raising awareness of the relevant infectious causes of febrile diseases in the country
3. Providing basic information for future clinical trials in the country

This project aims to create an active hospital surveillance system for undifferentiated acute febrile disease syndrome to determine the relative frequency of the following pathogens: Leishmania spp., Leptospira species., Rickettsia species., borellia species., brucella species., F. tularensis, K. burnetii, Crimean Congo hemorrhagic fever virus (CCFV), Handavirus and West Nile virus (WNV).

To gain a complete understanding of the etiology, clinical outcomes, and epidemiological characteristics of hospitalized patients with fever, the study website suggests becoming the main application for research at the new hospital. A second regional clinical center will be added during the 2nd year of follow-up. It is estimated that 600 patients will be included in the study within three years. Screening, enrollment, sampling and data collection, as well as sample testing will be conducted at the Nork Hospital and the country's National Center for Disease Control and Prevention (NCDC). The results of this study provide useful epidemiological and clinical information for relevant public health officials to plan for the future.  In addition, the results of this study will provide basic data for future research in the country.

NCDCP will also be involved in the data analysis process. 

The directory of medical researchers will be used as co-researchers in this study.  The handbook will assist in the development of a human use research protocol, on-site support for on-site implementation, and personnel to perform a monitoring function to ensure compliance with ethical and safety standards in accordance with applicable regulations in Armenia and the United States. The usamrd-G lab scientists will provide laboratory expertise for the study.

The handbook is funded by the Global Surveillance for Emerging Infectious Diseases (GIS) program to conduct this study. From the research budget, the training site (Nork Hospital) will receive all the materials (supplies, general laboratory supplies, reagents) for sample collection, processing and testing. Four doctors and three laboratory specialists will participate in the study at the Nork Hospital. These local research staff will receive training support with a fixed monthly fee, which will not depend on the number of registered patients. Two epidemiologists will be involved from NCDCP during the data analysis phase. They will also receive payment for tuition support. The handbook will provide preparation for the start of studies and professional development in relation to study-related procedures and ethical behavior in studies. 

15% of the samples will be sent to USAMRD-G for confirmatory testing. The specialists of the Armenian laboratory will visit the catalog to take part in the confirmatory testing of their samples. 

We expect that at least one manuscript will be published in a peer-reviewed International Journal. The Armenian researchers involved in the study will be the lead co-authors of the manuscript. All the results of this project will be used to develop recommendations for the Ministry of Health. I hope this project will be the first among many other joint projects between the country's Ministry of Health, the Directory and WRAIR.

The handbook requires a CVs for the MOG personnel involved in this proposed work to assess their experience and competence. 


The Directory looks forward to working with the Ministry of Health of the Republic of the Country to resolve this issue of serious public health concern.